The Risk Factors For Ecstasy And Related Drug Overdose: A Case-crossover Study
Funder
National Health and Medical Research Council
Funding Amount
$406,755.00
Summary
Our ability to respond to the emergent harms of Ecstasy and Related Drug (ERD) use is hampered by our lack of understanding of the practices users engage in that place them at risk of harm. This study will examine the risk factors for non-fatal ERD Emergency Department (ED) admission in a sample of non-fatal ERD overdose victims recruited through two hospital EDs in Melbourne. The research involves a case-crossover study of the risk factors for ERD-related ED admission, as well as a detailed cas ....Our ability to respond to the emergent harms of Ecstasy and Related Drug (ERD) use is hampered by our lack of understanding of the practices users engage in that place them at risk of harm. This study will examine the risk factors for non-fatal ERD Emergency Department (ED) admission in a sample of non-fatal ERD overdose victims recruited through two hospital EDs in Melbourne. The research involves a case-crossover study of the risk factors for ERD-related ED admission, as well as a detailed case series of ERD-related ED admissions. The case-crossover investigation will involve a comparison between behaviours occurring prior to the critical drug use episode with typical drug use behaviours and more specifically those occurring prior to a control use episode (another occasion on which ERDs were used). Data will be collected by Researchers positioned in the ED, with information collected on the specifics of the critical and control use episodes through interviews with participants following stabilisation and a return to consciousness. The case series will be established from all ERD-related ED admissions flagged as such by triage nurses. Potential risk factors under study will include the environmental conditions in which the drug was used (eg time of day, physical location), other drug taking behaviour, personal factors (eg asthma, depression) and other dose-related issues (eg amount purchased, source of purchase). Statistical analysis will establish the major differences between the critical, typical and control use episodes. The proposed research will examine risk factors for ERD-related harms within the context of an understanding of the usual practices and behaviour of users of these drugs. Identifying transient change in risk behaviours will provide a foundation for developing contextually-sensitive strategies for harm minimisation. The development of a detailed case series will impact upon the treatment and management of acute ERD-related harms.Read moreRead less
A Prospective Cohort Study Of Mortality, Abstinence, Criminality And Psychiatric Comorbidity
Funder
National Health and Medical Research Council
Funding Amount
$419,500.00
Summary
Over 70 000 Australians are dependent on heroin. Heroin dependence is remarkably persistent and is, in many cases, a lifelong condition. Long term treatment outcome and abstinence from heroin among this group are poor. Mortality among heroin users is high, with heroin users dying at a rate 13 times that of peers. Despite the extent of the problem, the natural history of heroin users has not yet been studied in Australia. The current study will be the first Australian study of the natural history ....Over 70 000 Australians are dependent on heroin. Heroin dependence is remarkably persistent and is, in many cases, a lifelong condition. Long term treatment outcome and abstinence from heroin among this group are poor. Mortality among heroin users is high, with heroin users dying at a rate 13 times that of peers. Despite the extent of the problem, the natural history of heroin users has not yet been studied in Australia. The current study will be the first Australian study of the natural history of heroin users. The study will follow up a large cohort of heroin users over a three year period. Estimates will be obtained of mortality rates, abstinence rates, criminal careers, and psychiatric problems among heroin users. It will also examine factors that predict abstinence, mortality, criminality and levels of psychopathology, and determine the health costs associated with heroin use careers. The study will provide essential data on how heroin use progresses, and on what factors predict a better outcome for heroin users.Read moreRead less
INVESTIGATING MORTALITY AMONG EX-PRISONERS IN QUEENSLAND: A DATA LINKAGE STUDY
Funder
National Health and Medical Research Council
Funding Amount
$716,801.00
Summary
NOTE: At the time of submitting the NOI for this project we had not yet received feedback from a submission to a parallel NHMRC funding round concerned with social disadvantage. We have since received very positive reviews for the trial foreshadowed in our NOI, and consistent with the recommendations of one reviewer, we have modified our application to complement the proposed trial by conducting a record linkage study. The content area and ethical issues associated with the proposed project rema ....NOTE: At the time of submitting the NOI for this project we had not yet received feedback from a submission to a parallel NHMRC funding round concerned with social disadvantage. We have since received very positive reviews for the trial foreshadowed in our NOI, and consistent with the recommendations of one reviewer, we have modified our application to complement the proposed trial by conducting a record linkage study. The content area and ethical issues associated with the proposed project remain largely unchanged. Studies in Australia and elsewhere have identified a heightened risk of death among ex-prisoners, with drug overdose, suicide and 'accidents' three major causes. Many deaths occur soon after release. Although the high incidence of 'overdose' among ex-prisoners is often attributed to reduced tolerance,most fatal drug overdoses are due to the combined effects of multiple drugs. A detailed understanding of deaths among ex-prisoners is a prerequisite for evidence-based preventive strategies. The proposed study will: (a) Link the identities of prisoners released from custody in QLD between 1994 and 2006, with the National Death Index (NDI). The linked database will permit exploration of the incidence, timing, causes and risk factors for death among ex-prisoners. (b) Compare correctional records of deceased ex-prisoners and a random sample of ex-prisoners known to be alive, focussing on suspected risk factors including criminal history, behaviour in custody, health status, psychosocial adjustment, socio-economic status, and history and treatment for drug use. This will allow more detailed analysis of risk factors for death post-release. (c) Conduct in-depth analysis of causes of death among ex-prisoners, using the National Coroners Information System (NCIS). Information regarding cause and context of death will be coded by a research assistant and analysed to identify group differences (e.g., between ATSI and non-ATSI ex-prisoners).Read moreRead less
A Investigation Of The Public Health Effects Of Retail Heroin Markets From A Consumer Perspective
Funder
National Health and Medical Research Council
Funding Amount
$189,106.00
Summary
The health problems associated with heroin use within our community are a major public health issue. Within the past decade there has been an increase in heroin-related deaths and evidence of the continuing spread of hepatitis C among individuals who inject heroin. Within this period there have been substantial changes in the heroin market in Australia, with street prices decreasing and purity increasing and we have witnessed the emergence of street markets in a number of major cities. The aim o ....The health problems associated with heroin use within our community are a major public health issue. Within the past decade there has been an increase in heroin-related deaths and evidence of the continuing spread of hepatitis C among individuals who inject heroin. Within this period there have been substantial changes in the heroin market in Australia, with street prices decreasing and purity increasing and we have witnessed the emergence of street markets in a number of major cities. The aim of the proposed research is to improve our understanding of the retail heroin market (that part of the market which is accessed by heroin users) by examining how the consumers (heroin users) use this market. The project will examine the relationship between the heroin market and the health problems associated with heroin use including dependence. The research will be conducted at 6 sites within metropolitan Melbourne which have been chosen on the basis that they have established street markets and high levels of non-fatal and fatal overdose. At each site interviews and surveys will be conducted with injecting drug users and others with knowledge of the local market and detailed observations will be made of street markets in each of these areas. This information will be combined with indicators of purity of heroin seized by police, fatal and non fatal-overdoses, police operations and arrests, and needle-syringe distribution and return. The information gathered in this research will be used to develop an understanding of the retail heroin market as a consumer market place and the impact of the market upon the health status of the individuals who use this market. The knowledge that we gain from this research will provide the foundation for developing more effective approaches to reducing the health problems associated with heroin use and for predicting the impact of changes in the market such as a reduction in price upon these problems.Read moreRead less
Assessing Naltrexone Implant Or Methadone Maintenance Treatment On Mental And Physical Health Outcomes In Heroin Users
Funder
National Health and Medical Research Council
Funding Amount
$216,200.00
Summary
The WA hospital data linkage system (DLS) will be used to assess differences in the mental and physical health of dependent heroin users prior to and post naltrexone implant or methadone maintenance treatment (MMT). MMT is the best established pharmacotherapy for the management of heroin dependence but oral naltrexone is gaining some acceptance. Currently funded by NHMRC, we are looking at outcomes with oral naltrexone using DLS data. Although effective in blocking heroin, management via oral na ....The WA hospital data linkage system (DLS) will be used to assess differences in the mental and physical health of dependent heroin users prior to and post naltrexone implant or methadone maintenance treatment (MMT). MMT is the best established pharmacotherapy for the management of heroin dependence but oral naltrexone is gaining some acceptance. Currently funded by NHMRC, we are looking at outcomes with oral naltrexone using DLS data. Although effective in blocking heroin, management via oral naltrexone has proved problematic, with medicine non compliance and relapse common. Surgical insertion of subcutaneous implants is an alternative method of naltrexone delivery. 441 heroin users have received naltrexone implants (3.4g) under Special Access in WA. Although naltrexone implants have yet to be comprehensively assessed, early results are encouraging. Pilot study data has shown a significant reduction in hospital emergency department (ED) attendance for accidental overdose, and mental health events following implant. The aim of this study is to more rigorously assess outcomes associated with implants compared to heroin dependent persons treated by MMT . The DLS collates general hospital and mental health admissions plus mortality data for individuals. This allows the health of an individual to be monitored over time. An electronic version of hospital ED data has recently become available. The study will validate these records by comparing the electronic data against hospital ED records for the implant group. We will then combine the electronic ED and DLS data. Morbidity and mortality rates for heroin users are significantly greater than those for the general population. If the preliminary findings are replicated, naltrexone implants may offer significant benefits over current pharmacotherapies in reducing general and psychiatric morbidity in dependent heroin users.Read moreRead less
Mortality In Young Offenders Who Have Had Custodial Sentences
Funder
National Health and Medical Research Council
Funding Amount
$60,448.00
Summary
The proposal seeks funding to investigate the death rate in young people who have received custodial sentences. There is evidence in the literature and anecdotal evidence from workers in the field that young offenders are at particularly high risk of dying from drug overdose, violently or by suicide, yet deaths in this group have not yet been investigated in Australia. As far as we are aware, there are also no reports worldwide of standardised mortality rates for young offenders who have been in ....The proposal seeks funding to investigate the death rate in young people who have received custodial sentences. There is evidence in the literature and anecdotal evidence from workers in the field that young offenders are at particularly high risk of dying from drug overdose, violently or by suicide, yet deaths in this group have not yet been investigated in Australia. As far as we are aware, there are also no reports worldwide of standardised mortality rates for young offenders who have been incarcerated. A group of young people who have received their first custodial sentences between 1988 and 1999 in Victoria will be identified, starting with 10 year olds in 1988. Their details will then be matched with data held by The National Death index, housed at the Australian Institute of Health and Welfare, and with the Victorian Coroner's data in order to identify deaths that have occurred, the cause of death and the circumstances of death. This will provide an index of the excess deaths experienced by this group of young offenders compared with Victorian population data for the same age group and gender. Further analysis will elucidate cause specific mortality, will enable the identification of subgroups at particular risk and the examination of trends over time. The study will provide a solid foundation for health priorities, the development of interventions and policy in relation to young offenders. It will provide a resource for Australasia and be of worldwide interest. Juvenile offenders are a well-defined group who has extended contact with support services. There is a unique opportunity for the delivery of interventions aimed at improving the welfare and adult outcomes of this enormously disadvantaged and marginalised section of our community. The Centre for Adolescent Health, as the auspicing body for the Adolescent Forensic Health Service is in an excellent position to respond to this challenge.Read moreRead less